Joy: You mentioned something most people don't know – wearing high heels causes your calf muscle to get bigger. No woman I know wants bigger legs. What causes this?

Bob: Tendons connect bone to muscle. The Achilles tendon connects the calcaneous (heel) bone to the gastrocnemius (calf) muscle. The calf muscle doesn't actually get "bigger," but high heels cause the Achilles tendon to push the gastrocnemius muscle upward against its insertion point behind the knee causing the muscle to compress and bulge, appearing to be much larger than when it is not so compressed.

Joy: You mentioned that many runway models get in trouble by wearing high heels. Can you explain this?

Bob: Fashion models spend their professional lives up on their heels. Their calf muscles are always being pressed up against the back of their knees and they bulge as a result. And whether they have diabetes or not, they put themselves in the peril of having their Achilles tendon snap when they finally do come down off those high heels. And because tendons are no longer growing tissue in the adult body, just like football players who may snap their Achilles tendon, the tendon will need to be surgically repaired and often a piece of extension material will have to be stitched between the two tendon halves in order to give it its proper length once everything has healed up.

Joy: Okay Bob, let's be real. You and I both know women are going to wear their high heels. What would you tell these women that don't yet get it?

Bob: As I mentioned earlier, ultimately the person must come to their own decision to protect their feet. If they insist…I'd tell them this:

  1. Never wear a heel higher than 2 inches for normal every day. For women who declare that they need to wear heels as part of their professional attire or to dressy functions, I'd recommend that they wear no more than 2-inch heels. Raising the heel of a shoe more than two inches begins to put too much pressure on the ball of the foot. And even then those shoe heels should be as wide as their foot heels, not mini-spikes. And they should take them off as soon as it's practical after the dinner or party or church service they wore them to. Minimize potential damage by minimizing the amount of time spent in inappropriate footwear.
  2. Consider your spiked high heels as "limousine shoes." I'd suggest wearing them while riding in the car to impress your date, your husband, your business colleagues, or whoever, but never stand up and walk on them!
  3. Understand that every time you are on them you are potentially damaging your foot. Every time you wear a shoe that fails to offer support or protection, or you stand up on a shoe that elevates your heel inappropriately and causes you to put extraordinary pressure on the balls of your feet, you are potentially damaging your foot's soft tissues (skin and underlying fat pads, in particular) which may ultimately lead to perilous consequences – for persons with diabetes in particular, but in reality, for everyone!

Joy: Thank you, Bob. I get it. I hope our readers do too. I've learned that I may have to look especially hard to find a shoe I love that works with my outfit. It may take a little more work, but that's not as much the suffering I'll experience if I get a wound from the pressure on the ball of my foot, or if I need surgery to fix a snapped tendon. Having diabetes really complicates these problems. And, speaking as a woman, I don't want bulging calf muscles!


Read Joy's bio here.

Read more of Joy Pape's columns.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.


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Last Modified Date: July 08, 2013

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